Peds Practice Questions

A 7-year-old child has been diagnosed with rheumatic fever. Which of the following physical findings would the nurse expect to assess? 1. Vesicular rash over the face and chest 2. Warm and swollen knees and elbows 3. Palpable mass in the upper right quadrant of the abdomen 4. Yellow pigmentation of the sclerae of the eyes

2. Warm and swollen knees and elbows Polyarthritis, one of the major manifestations of RF, is manifested by warm, swollen, and painful joints.

A 3-year old Native American child is admitted to the pediatric unit for emergency surgery. Which of the following questions should the nurse include when taking the admission history from the child's parents? 1. "Does your Indian tribe believe in immunizing children?" 2. "Do you attend Native American powwows with the family?" 3. "Have you consulted with your tribal healer about your child's illness?" 4. "What herbal remedies have you given your child today?"

3. "Have you consulted with your tribal healer about your child's illness?" Native American families often seek counseling from a tribal healer, so it is important to include that question.

A nurse is educating a parent regarding the immunizations that a child is to receive during the first year of life. Which of the following immunizations did the nurse discuss? 1. Measles 2. Mumps 3. Rubella 4. Polio

4. Polio The polio vaccine is administered in infancy.

A child has been diagnosed with Kawasaki disease. Which of the following signs and symptoms would the nurse expect to see? Select all that apply. 1. Diarrhea 2. Vertigo 3. Purpural rash over torso 4. Reddened and crusty eyes 5. Skin peeling from hands and feet

4. Reddened and crusty eyes 5. Skin peeling from hands and feet Children with Kawasaki disease do have conjunctivitis and the palms and soles of children with Kawasaki do desquamate. Kawasaki disease is diagnosed from a series of signs and symptoms, including prolonged fever, conjunctivitis, strawberry tongue, rash on the palms and soles that desquamates, and cardiac changes.

A mother asks the nursery school nurse, "Whenever she is playing with other children in the playground, my 2½-year-old keeps throwing sand in other kids' faces. What am I to do?" Which of the following disciplinary methods would be most appropriate for the nurse to recommend? a. Inform the child that she will be grounded from going to the playground for 7 days. b. Spank the child on her buttocks. c. Throw sand in the child's face. d. Make the child sit on a bench away from the playground for 2 to 3 minutes.

d. Make the child sit on a bench away from the playground for 2 to 3 minutes. Time out is an appropriate form of discipline for toddlers.

The nurse is obtaining a health history of a 6-year-old child who is being seen at the clinic for the first time. Which of the following questions should the nurse ask the child during the interview? Select all that apply. 1. "Do you have any pets at home?" 2. "Can you tell me how many 1 plus 1 makes?" 3. "Can you tell me the name of one of your school friends?" 4. "Can you tell me the names of any medicines that you take?" 5. "What kinds of things do you like to play during recess at school?"

1. "Do you have any pets at home?" 2. "Can you tell me how many 1 plus 1 makes?" 3. "Can you tell me the name of one of your school friends?" 5. "What kinds of things do you like to play during recess at school?" The questions that the nurse is asking the child will provide information regarding the child's progress in school, the child's environment, the child's social interactions, and the child's activity level. The parent, however, is responsible for medication administration.

The parent of a 7-year-old child telephones the nurse at the child's school and states, "My child has had a stomachache and headache every morning this week. Is there a virus going around the school?" Which of the following responses would be appropriate for the nurse to make at this time? Select all that apply. 1. "Has your child ever expressed any concerns about school?" 2. "Does your child seem to feel better once your child has missed school?" 3. "Has your child had any problems with any of the other children in school?" 4. "I would recommend taking your child to the child's primary health-care provider for a complete assessment." 5. "Unless your child is exhibiting additional symptoms like a fever or a rash, I would recommend that the child return to school."

1. "Has your child ever expressed any concerns about school?" 2. "Does your child seem to feel better once your child has missed school?" 3. "Has your child had any problems with any of the other children in school?" 5. "Unless your child is exhibiting additional symptoms like a fever or a rash, I would recommend that the child return to school." School refusal is a relatively common problem of the school-age period. The symptoms that the child exhibits are vague and subjective and frequently disappear once the parent permits the child to remain at home for the day

A child with Kawasaki disease is to receive IV immune globulin on day 7 of the illness. A parent asks the nurse, "I am so scared. Will my child be cured after getting the medicine?" Which of the following responses by the nurse is appropriate? 1. "I cannot promise, but children have been shown to have the best results from the medicine when it is given before the 10th day of the illness." 2. "I am sure that your child will be fine. This medicine has been shown to work well for children with Kawasaki disease." 3. "I really do not know. We will find out more when your child has follow up testing in 1 or 2 days." 4. "I know that you are scared, but it is important for you to have faith in your doctors because they are doing all that they can do."

1. "I cannot promise, but children have been shown to have the best results from the medicine when it is given before the 10th day of the illness." This is an appropriate response for the nurse to give. The nurse is providing correct information without making false promises.

A 12-year-old child has been diagnosed with group A strep pharyngitis. e primary health-care provider has ordered penicillin V 500 mg PO tid for 10 days. Which of the following questions is important for the nurse to ask the parents and the child before giving them the prescription? 1. "Is there any reason why you will not be able to take medicine 3 times a day for 10 days?" 2. "Would you rather get 1 shot or take 40 pills?" 3. "Have you ever had strep throat before?" 4. "Do you know of any other children in your school who have recently had sore throats?"

1. "Is there any reason why you will not be able to take medicine 3 times a day for 10 days?" It is important to be sure that the child will receive the entire 10 days of medication. If the parents or child state that they will be unable to complete the prescribed medication, the nurse should notify the ordering practitioner and suggest that an injection of penicillin G benzathine be administered instead.

The nurse has confirmed that a 9-year-old child understands the concept of conservation when the child makes which of the following statements? 1. "There is the same amount of clay in a snake made out of a ball of clay than there was when it was a ball." 2. "I don't get as tired when I ride up in an elevator than I do when I walk up a whole flight of stairs." 3. "I'd rather read books and play video games than to play baseball or soccer." 4. "I try to get my homework done as soon as I get home from school."

1. "There is the same amount of clay in a snake made out of a ball of clay than there was when it was a ball." A child understands the concept of conservation when he or she understands that when an object changes shape, it retains the properties that it had before its shape was changed.

A nurse is educating a group of parents regarding disciplinary actions that they can take if their preschool child disobeys. Which of the following recommendations should the nurse make? 1. "Up to a 5-minute time out is often very effective when a preschooler disobeys." 2. "At this age, it is appropriate and effective to spank the child lightly on the behind." 3. "When preschool children disobey, it is very effective to send them to their rooms without supper." 4. "An excellent form of punishment when a preschooler disobeys is to take away the child's favorite toy for a few days."

1. "Up to a 5-minute time out is often very effective when a preschooler disobeys." Preschool children are unable to conceptualize the meaning behind depriving them of a favorite toy for a number of days. It is much more effective to discipline the child immediately after the infraction by giving the child a time out for a few minutes.

A 4 ½-year-old child is being assessed after sustaining an injury. The child is reluctant to tell the nurse exactly how the injury occurred. Which of the following statements made to the child by the nurse would likely result in the child communicating with the nurse? Select all that apply. 1. "Would you please draw me a picture of what happened to you?" 2. "Would you please write me a story about what happened to you?" 3. "Here is a puppet friend of mine. Could he tell me what happened to you?" 4. "What if your friend were hurt in the same way. What would have happened to him?" 5. "I can't help you if I don't know what happened. Would you please tell me how you got hurt?"

1. "Would you please draw me a picture of what happened to you?" 3. "Here is a puppet friend of mine. Could he tell me what happened to you?" 4. "What if your friend were hurt in the same way. What would have happened to him?" Young children are wary of communicating with adults they do not know or trust. Using forms of play, including drawing, puppetry, and verbal storytelling, can often elicit responses in children.

An 8-year-old girl, who is complaining of a "really bad" sore throat and whose temperature is 102.2°F, is seen in the school nurse's office. The nurse has the child lie down in a room away from other children. Which of the following statements is most important for the nurse to convey when calling the child's parents? 1. "Your child should be seen by her primary care provider." 2. "Your child is very uncomfortable with a sore throat." 3. "Your child is crying and asking for mommy and daddy." 4. "Your child may be contagious to the other children."

1. "Your child should be seen by her primary care provider." This is the most important statement. The child may have a group A strep infection that will need to be treated.

A nurse is providing health promotion education to a 10-year-old child during a well-child clinic visit. Which of the following is an appropriate patient-care goal for the teaching session? The child will: 1. Brush teeth using a fluoride toothpaste at least twice each day. 2. Receive the first dose of the meningococcal vaccine before leaving the clinic. 3. Begin to take swimming lessons before becoming an adolescent. 4. Always ride a bicycle on the left-hand side of the road.

1. Brush teeth using a fluoride toothpaste at least twice each day. Because the secondary teeth must support the child throughout the child's life, it is critically important for the child to perform proper dental care each day.

A nurse is educating the parents of a 4½-year-old child regarding personal safety issues. Which of the following statements should the nurse include in the teaching? Select all that apply. The parents should: 1. Choose a safety word for the child to remember in cases of an emergency. 2. Warn the child to report any unfamiliar adult who offers the child candy or toys. 3. Inform the child that it is safe to be alone with any of the parents' friends or neighbors. 4. Advise the child to report any adult who attempts to touch the child's shoulders and back. 5. Instruct the child regarding the information that should be given when a 911 call is made.

1. Choose a safety word for the child to remember in cases of an emergency. 2. Warn the child to report any unfamiliar adult who offers the child candy or toys. 5. Instruct the child regarding the information that should be given when a 911 call is made. Preschool children should be taught, in a matter of fact way, regarding personal safety. They should be advised to report unwanted touching and strangers who try to entice them with candy, toys, and the like. They should be taught a safety word that only they and their parents know in case an emergency requires that and their parents know in case an emergency requires that someone other than their parents must care for them. They also should be taught when and how to call 911 and how to respond to the emergency operator who answers.

A child who has been diagnosed with chorea has been admitted to the pediatric unit with a diagnosis of rheumatic fever. Immediately prior to admission, the child's throat culture was positive for group A strep. Which of the following actions should the nurse perform when admitting the child? Select all that apply. 1. Cover the headboard with a soft material. 2. Put the child on droplet precautions. 3. Place a tracheostomy tray in the child's room. 4. Have the child perform active range of motion exercises. 5. Assess the child's apical heart rate for one full minute.

1. Cover the headboard with a soft material. 2. Put the child on droplet precautions. 5. Assess the child's apical heart rate for one full minute. A child with chorea from RF should be placed on seizure precautions. The headboard should be covered. The child's throat culture is positive for group A strep. The child should be placed on droplet isolation until he or she has received a full 24 hr of medication. The nurse should assess the child's apical pulse for 1 full minute to assess whether or not a murmur is present. A murmur would indicate that the child likely has carditis.

A toddler with Kawasaki disease is to receive IV immune globulin. Which of the following actions must the nurse perform? Select all that apply. 1. Discard the immune globulin if it appears cloudy. 2. Check the expiration date of the immune globulin. 3. Secure the arm to the arm board with a clear shield. 4. Document the lot number of the infusion in the child's medical record. 5. Allow the refrigerated immune globulin to warm in the microwave for 1 full minute.

1. Discard the immune globulin if it appears cloudy. 2. Check the expiration date of the immune globulin. 3. Secure the arm to the arm board with a clear shield. 4. Document the lot number of the infusion in the child's medical record. Immune globulin should be clear with no cloudiness or sediment. If either is present, the solution should be discarded. It is essential for nurses to check the expiration date of any medication administered to patients. Toddlers may unintentionally injure an IV site. To maintain its patency, therefore, the arm should be taped to an arm board, and a clear shield should be placed above the site for easy inspection. The lot number of the immune globulin should be documented in case serious side effects occur. All other bags of that lot number can then be examined and/or destroyed.

The school nurse is providing nutrition education to a group of high school students. Which of the following information should be included in the teaching session? Select all that apply. 1. Energy drinks are high in sugar and caffeine. 2. Vegan diets are low in complete proteins. 3. Fast foods are low in fat and cholesterol. 4. Sodas are high in sugar and empty calories. 5. Adolescents often need to limit their intake of calories.

1. Energy drinks are high in sugar and caffeine. 2. Vegan diets are low in complete proteins. 4. Sodas are high in sugar and empty calories. Energy drinks and sodas are high in sugar and caffeine. It is recommended that teens limit their intake of energy drinks. Vegan diets are low in complete proteins. If teens choose to follow a vegan diet, they will need professional assistance to make sure that they consume adequate quantities of protein and other nutrients.

The nurse working in a local school district is developing the curriculum for a new sex education program for the 2nd grade students. Which of the following content would be appropriate to include in the class? 1. External genitalia of males and females 2. List of names of the registered sex offenders living in the school district 3. Difference between heterosexual contact and homosexual contact 4. Etiology of human immunodeficiency virus

1. External genitalia of males and females Including sex education in young children's school curriculum is a controversial subject. If it is decided to include it in the children's education, a recommendation has been made regarding the content that should be included at each age level.

The nurse is assessing the posture of a 13-month-old child who has been walking for 1 month. Which of the following findings should the nurse determine are within normal limits? Select all that apply. 1. Flat-footedness 2. Kyphosis 3. Lordosis 4. Wide, waddling gait 5. Bow-leggedness

1. Flat-footedness 3. Lordosis 4. Wide, waddling gait 5. Bow-leggedness If the test-taker remembers that the toddler has weak abdominal muscles and large abdominal organs, it is understandable that the toddler would be lordotic. The wide, waddling gait helps toddlers to lower their center of gravity and, therefore, better enable them to walk on two feet.

A 9-year-old child is being seen in the pediatrician's office after experiencing a head injury. The nurse assesses the child's vital signs as: TPR - 98.0 F, HR: 52 bpm, RR: 12 rpm, and BP: 88/50 mm Hg. The child's capillary refill is 2 sec. Which of the following actions would be appropriate for the nurse to take? 1. Immediately notify the primary health-care practitioner of the findings. 2. Ask the child to describe how the head injury occurred. 3. Immediately administer two rescue breaths. 4. Carefully examine the child's head for signs of fracture.

1. Immediately notify the primary health-care practitioner of the findings. The nurse should immediately notify the practitioner of the findings. A HR less than 60 bpm with poor perfusion would warrant the beginning of chest compressions.

A nurse is educating a parent regarding the psychosocial stage of development of the infancy period. Which of the following information did the nurse include in the discussion? 1. Infants should have their needs met in a timely fashion. 2. Mothers should let their babies cry themselves to sleep each night. 3. Infants should be scolded for bad behavior whenever they break objects. 4. Mothers should sneak out of the room when they must leave their babies.

1. Infants should have their needs met in a timely fashion. The Eriksonian psychosocial stage of the infancy period is trust vs mistrust. Infants develop trust when they become assured that their parents will meet their needs.

A school nurse is providing an education session for parents of high school students. Which of the following information should be included in the teaching session? 1. It is important for teens to catch up on their sleep on weekends. 2. Teens are less likely to get into an automobile accident if others are in the car with them. 3. Adolescents are especially at high risk for accidental poisonings. 4. Tanning beds are safe as long as the adolescent reapplies sunscreen every ten minutes.

1. It is important for teens to catch up on their sleep on weekends. Teens often stay up late at night but must rise early for school. As a result, they sleep many fewer hours than the recommended 8 or more hours each weeknight. To make up for the lack of sleep, teens need to "catch up" on weekends, often sleeping 10 to 12 hours each night. Unfortunately, parents often perceive the long sleep periods as laziness.

The parents of a hospitalized 2 ½-year-old child tell the nurse and the child that they must leave the hospital to care for their children who are at home. Which of the following responses would the nurse expect the child to exhibit? 1. Kicking and crying 2. Waving goodbye 3. Sucking a thumb 4. Hugging a doll

1. Kicking and crying The nurse would expect the child to exhibit the characteristic signs of the protest stage of separation. Toddlers tend to exhibit the most pronounced behaviors when they must be separated from their parents.

An 18-year-old, who is being seen for a routine dental examination, is told that 2 wisdom teeth are impacted. Which of the following complications should the adolescent and his parents be advised may develop? Select all that apply. 1. Pain 2. Cysts 3. Infections 4. Tooth misalignment 5. Mandibular osteopenia

1. Pain 2. Cysts 3. Infections 4. Tooth misalignment Pain is a common complication of impacted wisdom teeth. Cysts may develop where the wisdom teeth erupt. Infections of the gums or other structures may develop as a result of wisdom tooth impaction. Tooth misalignment is a common complication.

A mother questions the nurse regarding car seat safety for her infant. Which of the following information should the nurse include in the discussion? 1. Place the infant car seat rear facing in the back seat of the car. 2. Move the car seat to the forward-facing position when the child reaches 1 year of age. 3. Keep the child in a bucket seat until the child is at least 12 months of age. 4. Tighten the straps of the seat so that only an adult fist fits under the straps.

1. Place the infant car seat rear facing in the back seat of the car. The recommendation was changed for those still meeting the height and weight requirements of the seats to stay rear facing until 2 years of age.

An 8-month-old is seen in the well-child clinic. Which of the following behaviors would the nurse expect to see? Select all that apply. 1. Plays peek-a-boo 2. Walks independently 3. Feeds self with a spoon 4. Stacks two blocks into a tower 5. Transfers objects from hand to hand

1. Plays peek-a-boo 5. Transfers objects from hand to hand 8-month-old children do play peek-a-boo with their parents. Babies can transfer objects from hand to hand at 7 months of age.

The nurse is developing a plan of care to prevent separation behaviors in children who are hospitalized for long periods of time. Which of the following items should the nurse include in the plan of care? Select all that apply. 1. Provide the child with the child's favorite transitional object. 2. When possible, assign the same nurse to care for the child each day. 3. Admit the child to the patient room that is closest to the nurse's station. 4. Tape pictures of the child's friends and family members to the walls of the child's hospital room. 5. Inform the parents that at least one person must stay with the child at all times during the hospitalization.

1. Provide the child with the child's favorite transitional object. 2. When possible, assign the same nurse to care for the child each day. 4. Tape pictures of the child's friends and family members to the walls of the child's hospital room. Although it is ideal for at least one parent to stay with a child during the child's hospitalization, it is not always possible. For example, the parents may have to work, they may live miles away from the hospital, or they may need to be at home to care for the child's siblings. To maintain a strong relationship between the child and his or her parents, the nurse should implement actions as stated above as well as encourage direct communication via a number of routes (e.g., via telephone, texting, video conferencing).

To enhance the effectiveness of the pharmacological pain intervention administered to a 4-year-old child with an injured knee, the nurse plans to add a nonpharmacological pain intervention. Which of the following actions would be appropriate for the nurse to perform? Select all that apply. 1. Read a book to the child. 2. Hold and cuddle with the child. 3. Put an ice pack on the child's knee. 4. Have the child watch a favorite program on television. 5. Perform passive range of motion exercises on the injured knee.

1. Read a book to the child. 2. Hold and cuddle with the child. 3. Put an ice pack on the child's knee. 4. Have the child watch a favorite program on television. Distraction is an excellent nonpharmacological intervention. The nurse could read a book to the child. Holding and cuddling with a child can enhance the therapeutic action of a pain medication. Putting an ice pack on the child's knee could enhance the therapeutic action of a pain medication. Distraction is an excellent nonpharmacological intervention. The nurse could let the child watch a favorite program on television.

The nurse is preparing to perform an examination of a 2-year-old boy. The child's mother is present. At the start of the examination, which of the following actions by the nurse may help to prevent a negative response from the child? 1. Refrain from touching the child, and speak directly to the child's mother. 2. Gently touch the child's hair while looking directly into his eyes. 3. Smile broadly while placing the bell of the stethoscope on the child's chest. 4. Ask the child to describe his favorite television show or favorite toy.

1. Refrain from touching the child, and speak directly to the child's mother. When the nurse waits to touch the toddler and speaks directly to the child's mother, the toddler begins to see that the mother trusts the nurse and, therefore, is more likely to begin to trust the nurse.

A 13-year-old adolescent is in hospital for reconstructive surgery after a severe automobile accident. During rounds, the nurse notes that the teen is watching television and playing a video game. Which of the following should the nurse assess regarding the patient's well-being? Select all that apply. 1. Teen's pain level 2. How often friends visit the teen 3. Level of healing of the teen's surgical site 4. Teen's progress on daily homework assignments 5. How well the teen is performing on the video games

1. Teen's pain level 2. How often friends visit the teen 3. Level of healing of the teen's surgical site 4. Teen's progress on daily homework assignments When a nurse is performing holistic nursing care in the pediatric setting, he or she must assess not only the physiological aspects of the child's well-being but also the psychosocial aspects. Completion of the child's homework is one of those aspects.

A nurse is providing education to the parents of a toddler. Which of the following information should the nurse include? Select all that apply. 1. The child should receive an influenza vaccination every year. 2. The child should brush his or her teeth with toothpaste every morning and night. 3. The child should consume foods from all food groups every day. 4. The child should continue to drink formula until he or she is two years old. 5. The child should be allowed to take his or her special object to nursery school.

1. The child should receive an influenza vaccination every year. 5. The child should be allowed to take his or her special object to nursery school. Children should receive the influenza vaccine every year. Transition objects should accompany toddlers during new experiences.

A nurse is providing anticipatory guidance to a young man who is at Tanner stage 2. Which of the following information should the nurse discuss with the young man? 1. Voice changes 2. Sexually transmitted infections 3. Condom use 4. Nocturnal emissions

1. Voice changes The child is in Tanner stage 2. He will not reach sexual maturation until he is in Tanner stage 5. He will, however, begin to experience vocal changes. The nurse should forewarn him of those changes.

Parents inform the nurse that their 4½-year-old daughter "stutters a lot." The nurse should advise the parents to do which of the following? Select all that apply. 1. Wait patiently for the child to complete her sentences. 2. Give the child a treat whenever she speaks clearly. 3. Look directly at the child while she is speaking. 4. Respond to the child by speaking slowly and clearly. 5. Refrain from making any comments about the stuttering.

1. Wait patiently for the child to complete her sentences. 3. Look directly at the child while she is speaking. 4. Respond to the child by speaking slowly and clearly. 5. Refrain from making any comments about the stuttering. Parents frequently state that their preschoolers stutter. However, if the parents respond appropriately, the behavior rarely becomes a lifelong problem. The best way to respond to the child is to bring as little attention, either verbally or nonverbally, to the problem as possible.

During a well-child visit, the nurse asks the parents and their 11-year-old child about safety issues. In which of the following situations should the nurse provide disease prevention education? 1. When playing in the sun, the child applies sunscreen every 4 hours. 2. When riding in the car, the child sits in the backseat in a car restraint system. 3. When rollerblading on the driveway, the child wears body and head protection. 4. When baking something in the oven, the child wears 2 oven mitts and is assisted by a parent.

1. When playing in the sun, the child applies sunscreen every 4 hours. By 11 years of age, children are performing many sophisticated skills independently. This independence places the children at risk for injury. The children should be reminded to apply sunscreen at least every 2 hours while playing in the sun.

The parents of an infant have just been informed by the infant's primary health care provider that their child has an aggressive form of cancer. The parents have previously communicated that they are Jewish. Which of the following statements would be appropriate for the nurse to make? "It is often comforting for parents of very sick children to: 1. speak with their rabbis." 2. read the sacred scriptures of Jesus." 3. go to their church to pray." 4. consult with members of the mosque."

1. speak with their rabbis." It is appropriate to suggest to clients that they seek counsel with their religious advisor. The Jewish spiritual leader is called a rabbi.

The mother of a 5½-year-old child who is 36 inches tall and who weighs 42 pounds states that the child complains every time she attempts to strap her child into the car seat. The nurse searches the Internet and finds the specifications of the child's car seat are as follows: ● Maximum weight forward facing: 40 lb ● Minimum weight forward facing: 22 lb ● Maximum weight rear facing: 40 lb ● Minimum weight rear facing: 5 lb ● Maximum height forward facing: 40 in. ● Minimum height forward facing: 28 in. Which of the following statements would be appropriate for the nurse to make at this time? 1. "Because your child is not yet 40 inches tall, the child should still sit in the car seat." 2. "Because your child is over 40 pounds, the child should now be sitting in a booster seat." 3. "The minimum height of 28 inches means that your child would be safer if the child were sitting in a booster seat." 4. "The minimum weight for forward facing is 22 pounds, so your child may now sit in a booster seat in the car."

2. "Because your child is over 40 pounds, the child should now be sitting in a booster seat." The National Highway Traffic Safety Administration recommends that once preschool children exceed the height and weight limits of their car restraint systems, they should be seated in the back seat of cars in booster seats until shoulder and lap belts fit correctly.

The parents of a 10-month-old is being interviewed by the nurse preceding an examination by the pediatric nurse practitioner and states, "My baby loves all kinds of food, and he always drinks his milk from a sippy cup, except in the evening when he wants a bottle." Which of the following follow-up questions is most important for the nurse to ask? 1. "Have you decided when you will wean your child from the bottle entirely?" 2. "Is your child drinking cow's milk from the sippy cup and bottle? 3. "Which fruits and vegetables have you fed your child so far?" 4. "Have you fed your child any foods that he can feed himself, like cereal or peas?"

2. "Is your child drinking cow's milk from the sippy cup and bottle? Babies should consume either breast milk or a commercially prepared formula until 1 year of age. Pure cow's milk contains fats, proteins, and carbohydrates that are in much different proportions than those found in breast milk and formula.

The nurse is assessing whether or not an 8-year-old child has given assent for a scheduled painful procedure. Which of the following statements by the child would reflect that the child has given assent? 1. "I know that the procedure is supposed to make me better." 2. "The procedure is going to be done at 10 a.m. this morning." 3. "Dr. Jones wants to perform the procedure on me." 4. "My mother signed the form that the doctor brought in."

2. "The procedure is going to be done at 10 a.m. this morning." When a child provides assent for a treatment or procedure to be performed, he or she is making an implicit or explicit statement that the treatment or procedure may be performed.

The nurse is caring for a 14-year-old adolescent after a serious injury. A twice-daily dressing change has been ordered by the child's primary health-care provider. When planning care with the patient, which of the following statements would be best for the nurse to make? 1. "I'll be in to change your dressing twice today." 2. "When do you think will be the best times for me to change your dressing?" 3. "I'm going to have you help me when I change your dressing." 4. "Can you help me to figure out how best to change your dressing?"

2. "When do you think will be the best times for me to change your dressing?" To become a unique individual, teens seek to become more and more independent. When the nurse solicits the teenager's help in determining when the dressing should be changed, the nurse is providing the teen with some independence.

The neonatal cardiologist orders digoxin (Lanoxin) for a newborn in congestive heart failure. The baby weighs 7 lbs 8 oz and is 21 inches long. e drug reference states: for full-term newborns, 8 to 10 mcg/kg/day in divided doses every 12 hr. Which of the following orders would be safe for the nurse to administer? 1. 10 mcg PO every 12 hr 2. 15 mcg PO every 12 hr 3. 20 mcg PO every 12 hr 4. 25 mcg PO every 12 hr

2. 15 mcg PO every 12 hr Fifteen mcg PO every 12 hr is between the minimum and the maximum recommended dosages for digoxin and is the correct response.

While performing a chest assessment on an 11-month-old child, the nurse palpates for the cardiac point of maximum intensity (PMI). The nurse would expect the PMI to be felt at the: 1. 3rd intercostal space, to the left of the sternum. 2. 4th intercostal space, lateral to the midclavicular line. 3. 5th intercostal space, at the midclavicular line. 4. 6th intercostal space, to the right of the axilla.

2. 4th intercostal space, lateral to the midclavicular line. Until a child reaches about 7 years of age, the PMI is found at the fourth intercostal space lateral to the midclavicular line.

A nurse is preparing to give a 5-year-old child preoperative teaching for abdominal surgery. Which of the nurse's actions is most appropriate? 1. Explain the procedures that the child will experience. 2. Allow the child to dress up in surgical attire. 3. Tell the child why the surgery will make the child healthier. 4. Have the child meet another child who has had surgery.

2. Allow the child to dress up in surgical attire. The best way to enable young children to understand what actions will take place is to allow them to perform the actions themselves. They then have a clear understanding of what will happen.

A school nurse determines that a group of young women is in early adolescence based on which of the following observations? All of the young women: 1. Have decided on which career they wish to pursue. 2. Are dressed in the same style clothes and wear the same hairdos. 3. Broke curfew by staying late at a party they all went to. 4. Brag about drinking beer when their parents are at work.

2. Are dressed in the same style clothes and wear the same hairdos. Erik Erikson's psychosocial stage of the teen years, identity versus role confusion, is often broken down into three phases: early, middle, and late. Early adolescence is considered the phase of conformity, middle adolescence as the phase of challenge, and late adolescence as the phase of individuality.

The nurse enters the examination room of a mother and her 8-month-old. The baby is asleep in the mother's arms. Which of the following actions would be best for the nurse to perform at this time? 1. Ask the baby's mother for an updated history since the last well-child check. 2. Auscultate the baby's heart, lung, and bowel sounds. 3. Begin a full body assessment, starting with the baby's head and neck. 4. Wake the baby by playing with the baby's toes and feet.

2. Auscultate the baby's heart, lung, and bowel sounds. An 8-month-old is likely to be exhibiting signs of stranger anxiety. Once awake, therefore, he or she will likely cry when touched by the nurse. It is best to auscultate the heart, lungs, and bowel sounds while the child is quiet and sleeping.

A 6-month-old child received the following play things as a gift from a relative. The nurse should advise the parents that which of the items is potentially dangerous for the child to play with? 1. Stuffed animal 2. Balloon 3. Toy cell phone 4. Shape shorter

2. Balloon Balloons are potentially dangerous items for young children. A young child could easily inhale either an uninflated or broken balloon and suffocate when putting the item in their mouth.

A child's 3rd grade teacher informs the parents, "Your child's handwriting is quite poor. It is important that your child practice skills that might improve the handwriting." Which of the following activities could the parents encourage the child to perform? Select all that apply. 1. Throw a ball back and forth 2. Begin to play a musical instrument 3. Build a model of a favorite structure 4. Learn a new and popular dance 5. Draw or paint a colorful picture

2. Begin to play a musical instrument 3. Build a model of a favorite structure 5. Draw or paint a colorful picture Handwriting is a fine motor skill. To improve the handwriting, it would be appropriate for the child to be encouraged to practice other fine motor skills, including playing a musical instrument, building a model, and/or creating a piece of studio art.

The mother of a 2-month-old who is being seen in the pediatrician's office states, "l am really worried because my child's head is not shaped right." The nurse should ask a question to obtain which of the following information? 1. Is the child yet able to roll over by himself? 2. Do the parents put the child on his stomach during supervised play? 3. Is the child turning his head to follow an object? 4. Do the parents elicit a smile from the child when they speak to him?

2. Do the parents put the child on his stomach during supervised play? Babies often develop plagiocephaly when they are placed on their backs all day everyday. To prevent this, parents are strongly encouraged to place their babies on their each day.

A 4-year-old child, who is hospitalized with pneumonia, tells the nurse, "I got sick because I was bad. I yelled at my little sister yesterday." The nurse determines that which of the following is an accurate explanation for the child's comment? The child is: 1. Trying to get sympathy from the nurse. 2. Exhibiting an example of magical thinking. 3. Making up stories to entertain the nurse. 4. Expressing remorse for having yelled at her sister.

2. Exhibiting an example of magical thinking. The Eriksonian psychosocial development stage of the preschool child is initiative versus guilt. Children during this stage of development often believe that their thoughts are powerful (i.e., that they can cause injury simply by having angry thoughts or expressing angry words and, unless they are told otherwise, they can become guilt-ridden).

The nurse is assessing a 12-year-old boy during a well-child clinic visit. Which of the following findings would the nurse expect to see? 1. Weight gain of 2¼ lb (1 kg) since the last visit 1 year previously 2. Height increase of 2 in. (5.5 cm) since the last visit 1 year previously 3. 20 secondary teeth 4. Heart rate 124

2. Height increase of 2 in. (5.5 cm) since the last visit 1 year previously On average, school-age boys grow about 2 in., or 5.5 cm, each year. If the child had been a 12-year-old girl, the growth figures may have been quite different because girls often experience their pubertal growth spurts when they are 11 or 12.

A nurse in a day-care center is observing a 2-year-old child during recess. Which of the following actions would the nurse expect the child to perform? 1. Ride a tricycle 2. Kick a ball 3. Climb the rungs of a ladder 4. Build a sand castle

2. Kick a ball Understanding normal growth and development is very important. Only when normal growth and development are understood is it possible for health-care providers to know when children are not developing normally and in need of early intervention.

A 2 1⁄2-year-old child is in the hospital with Kawasaki disease. Which of the following actions by the nurse is important for the child's psychosocial care? 1. Place the child in a single-bedded room. 2. Make sure the child always has his transitional object with him. 3. Supply the child with board games for play. 4. Let the child see what he looks like in a surgical mask and cap.

2. Make sure the child always has his transitional object with him. Transition objects (e.g., blankets, dolls, pacifiers) help toddlers to deal with stressful situations. Unless medically contraindicated, nurses should make sure that young children are in possession of their transition objects at all times while in the hospital.

An 18-month-old child has just returned from the operating room with intravenous solution running into a vein in the right hand, a nasogastric tube in place, and a dressing covering the abdomen. Which of the following actions by the nurse would be appropriate? Select all that apply. 1. Administer an NSAID per the health-care provider's orders. 2. Place an intake and output sheet at the child's bedside. 3. Request an order for an elbow restraint for the child's left arm. 4. Assess the child's pain level using an age-appropriate pain rating scale. 5. Compare the intravenous solution to the health-care provider's orders.

2. Place an intake and output sheet at the child's bedside. 3. Request an order for an elbow restraint for the child's left arm. 4. Assess the child's pain level using an age-appropriate pain rating scale. 5. Compare the intravenous solution to the health-care provider's orders. It would be inappropriate for the nurse to administer an NSAID per the health-care provider's orders. If the child is in pain, he or she should receive a narcotic analgesic medication immediately postsurgery.

To promote language development in the adolescent, parents, educators, and health-care professionals should encourage teenagers to perform which of the following activities? 1. Surf the Internet 2. Read a variety of literature 3. Engage in public speaking 4. Write letters

2. Read a variety of literature By the school-age period, children have acquired the ability to engage in conversation and to use all parts of speech. Reading a variety of literature is recommended to enhance their vocabularies and to improve their scholarly writing during their adolescent years.

The parents of a toddler, who is toilet trained and no longer drinks from a bottle, are expecting a new baby. The nurse should advise the parents that the toddler may respond in which of the following ways? Select all that apply. 1. Kiss the baby whenever the baby is near. 2. Repeatedly have temper tantrums. 3. Ask to drink milk from a bottle. 4. Have a number of toileting accidents. 5. Hit the baby on the head.

2. Repeatedly have temper tantrums. 3. Ask to drink milk from a bottle. 4. Have a number of toileting accidents. 5. Hit the baby on the head. Because parents are excited and in love with the new baby as well as their older child, they often do not realize that the toddler may not have the same feelings. Indeed, the new baby is taking his or her parents' time and attention away from him or her. As a result, toddlers often regress and become angry.

A school nurse is providing an educational session for parents of high school students. Which of the following actions should the nurse encourage parents to perform in relation to the moral development of their teenagers? 1. Threaten a severe consequence if their child breaks any rules. 2. Role-model ethical and moral behavior in their everyday lives. 3. Take their child on a trip to the local jail to show what happens when adults break the law. 4. Require their child to sign an honor pledge never to break house rules or to break the law

2. Role-model ethical and moral behavior in their everyday lives. Adolescents are aware of rules and laws and know that they are expected to abide by those restrictions. They challenge those expectations, however, when they observe their parents and other adults failing to comply with legal restrictions. When parents role model appropriate behavior, they are reinforcing the expectations that they are placing on their children.

A 13-year-old girl, 61 inches tall, is seen for a yearly checkup. She tells the nurse, "I'm the shortest one of my friends. Do you think that I'll grow anymore?" In which of the following situations is it most likely that the young woman will continue to grow? 1. Her growth spurt began when she was 9 years old. 2. She started to menstruate 3 months earlier. 3. She is at the 75th percentile for weight. 4. Her parents are both average for height and weight.

2. She started to menstruate 3 months earlier. Young women usually continue to grow for approximately 2 years after menarche.

The school nurse is observing an 18-month-old child during lunchtime in the nursery school cafeteria. Which of the following behaviors would the nurse expect to see? 1. The child eats everything with her fingers. Picks up a bottle with 2 hands and drinks. 2. The child uses a spoon but drops quite a bit. Picks up a sippy cup with 2 hands and drinks. 3. The child uses a spoon and drops very little. Picks up a regular cup with 2 hands and drinks with some spillage. 4. The child uses a fork and drops very little. Picks up a regular cup with 1 hand and drinks with no spillage.

2. The child uses a spoon but drops quite a bit. Picks up a sippy cup with 2 hands and drinks.

A baby, exhibiting no obvious signs of congestive heart failure, has been diagnosed with a small ventricular septal defect. Which of the following information should the nurse explain to the baby's parents? 1. The baby will likely need open-heart surgery within a week. 2. The defect will likely close without therapy. 3. The defect likely developed early in the second trimester. 4. The baby will likely be placed on high-calorie formula.

2. The defect will likely close without therapy. The majority of small VSDs close spontaneously. The vast majority of babies with VSDs are discharged from the well-baby nursery and are seen periodically by a cardiologist on an outpatient basis. This can be frightening to the parents who are told that their baby has a hole in his or her heart. It is important, therefore, for the nurse to reassure the parents that most VSDs do close spontaneously. However, the nurse must educate the parents regarding signs of CHF in case the baby does begin to go into cardiac failure.

A baby that was born 5 minutes earlier is tachypneic, tachycardic, and markedly cyanotic. A STAT echocardiogram confirms the presence of a cyanotic congenital cardiac defect. Which of the following defects would be consistent with the assessment findings? 1. Patent ductus arteriosus 2. Transposition of the great vessels 3. Atrial septal defect 4. Ventricular septal defect

2. Transposition of the great vessels Transposition of the great vessels (TGV) is a cyanotic defect. Unless another defect is also present, the defect is incompatible with life.

The nurse is assessing the dental development of a 7-month-old child. Which of the following findings would the nurse expect to see? 1. No teeth: drooling and chewing behavior 2. Two teeth: lower incisors 3. Two teeth: upper incisors 4. Four teeth: both upper and lower incisors

2. Two teeth: lower incisors Although tooth development may be slightly early or slightly delayed, the progression of tooth eruption is usually consistent. Also, it is important for the nurse to educate the parents that once the child begins to have teeth, they should be cleaned each day.

A mother of an 8-month-old boy states that the family is vacationing in a beach house for the next 2 weeks. Which of the following information should the nurse educate the mother about in relation to sun exposure? Select all that apply. 1. Reapply sun lotions to all exposed skin every 4 to 6 hours. 2. Use sun lotions that protect against both UVA and UVB rays. 3. Have the baby wear child-sized sunglasses whenever he is in the sun. 4. Avoid exposing the child to the sun between the hours of 12 and 2 p.m. 5. Dress the child in lightweight clothing that covers the majority of his skin.

2. Use sun lotions that protect against both UVA and UVB rays. 3. Have the baby wear child-sized sunglasses whenever he is in the sun. 5. Dress the child in lightweight clothing that covers the majority of his skin. Sun lotions should only be used if they protect against both UVA and UVB rays. Not only should the skin be protected from the sun. The eyes also should be protected. Clothing will help to protect the skin from sun exposure.

A parent asks the nurse the following question: "My son plays with his penis all the time. What should I do?" Which of the following responses is appropriate for the nurse to give the parent? "Advise your child that: 1. he should touch his penis only when he is urinating." 2. the behavior is appropriate when he is alone in a private place." 3. only boys who are old enough to have sex should touch their penises." 4. bad men may try to hurt him if they see him playing with his penis."

2. the behavior is appropriate when he is alone in a private place." Masturbation is a normal, natural act that is evident throughout childhood and adulthood. It is inappropriate to scold a child or to frighten a child when he or she masturbates. It is appropriate, however, to remind a child that private acts should be performed in private places

The nurse is providing anticipatory guidance to the parents of a 12-month-old child regarding bedtime issues. Which of the following statements is appropriate for the nurse to include? 1. "Don't put your child to bed each night until he appears to be really sleepy." 2. "Make sure to keep blankets, pillows, and stuffed toys out of your child's bed." 3. "Forewarn your child a few minutes before that it is time to go to bed. In other words, tell him when it is ten minutes before and then five minutes before bedtime." 4. "Make bedtime different and special every night. Some nights you could read him a story, other nights play a game with him, and other nights sing a song with him."

3. "Forewarn your child a few minutes before that it is time to go to bed. In other words, tell him when it is ten minutes before and then five minutes before bedtime." Bedtime rarely is difficult when parents establish a set pre bedtime routine and follow the routine consistently. Toddlers accept change much easier when they are forewarned of the change

A nurse is providing health promotion education to the parent of a 6-year-old child during a well-child clinic visit. Which of the following statements by the parent would indicate that further teaching is needed? 1. "Eating raisins and jelly beans is worse for my child's teeth than is drinking sugary soft drinks." 2. "My child loves to kick balls around the yard, so I think I will enroll my child in a soccer camp." 3. "I let my child watch television for a half hour in bed after bedtime when my child has been really good." 4. "My child took a pack of gum from the local store the other day, so I made my child give it back to the manager."

3. "I let my child watch television for a half hour in bed after bedtime when my child has been really good." This parent needs further education. If a child is unable to go directly to sleep, he or she should be encouraged to read in bed rather than to engage in such activities as watching television, playing video games, and playing on the computer.

A nurse is interviewing a group of 4th grade children. It would be appropriate for the nurse to diagnose the child who made which of the following statements as at "Risk for Altered Coping related to poor psychosocial development"? 1. "My teacher put the picture I drew up on the board." 2. "I made a goal during our soccer game yesterday." 3. "I strike out every time I bat when we play softball in gym class." 4. "My teacher let me read out loud last week and again this week."

3. "I strike out every time I bat when we play softball in gym class." The Eriksonian stage of the school-age period is called industry versus inferiority. Children try hard to succeed, but when they repeatedly are unable to achieve what they consider to be a successful result, they may develop a feeling of inferiority.

A second grader enters the school nurse's office crying and states, "I feel sick. My belly hurts." The nurse replies, "I'll call your mommy or daddy to pick you up." The child replies, "I don't have a mommy. I have 2 daddies." Which of the following comments by the nurse is appropriate? 1. "That's right. I forgot that your parents are gay." 2. "Of course you have a mommy. You just don't live with your mommy." 3. "I'll call one of your daddies to pick you up." 4. "It must be interesting to live with two men and no women in the house."

3. "I'll call one of your daddies to pick you up." The children should never be made to feel that the family structure is abnormal.

A parent telephones the nurse in the primary health-care provider's office and states, "My 4½-year-old child was screaming and kicking in her sleep. She really scared me, but by the time I got into her bedroom, she seemed to be quiet again. What should I do if that happens again?" Which of the following responses by the nurse is appropriate? 1. "The best way to stop night terrors is to have your child talk about her fears during the day." 2. "The best way to deal with nightmares is to keep a night light lit in your child's room all night." 3. "Night terrors usually go away on their own just like your daughter's did. It is best not to awaken the child." 4. "Nightmares are very common in children your daughter's age. Next time wake her up, and tell her that she is safe."

3. "Night terrors usually go away on their own just like your daughter's did. It is best not to awaken the child." Night terrors are characterized by crying and agitation while still asleep. Children usually remain asleep and calm down spontaneously. It is best not to awaken children from night terrors.

A nurse has been assigned to care for a 12-year-old child who will likely die from his illness. The child asks the nurse, "Do you think I am going to die?" Which of the following responses would be appropriate for the nurse to make? 1. "Don't talk like that. You are going to get better very soon." 2. "It would be best if you were to ask your doctor about that." 3. "Some children who have been diagnosed with your illness do die." 4. "It's hard for me to talk about death. It would be best if you were to ask your parents."

3. "Some children who have been diagnosed with your illness do die." Children who are dying often sense that death is near. If they ask about death, it is important for the nurse to give an honest answer. If the nurse evades the question or gives a dishonest answer, the child will have difficulty trusting the nurse in the future.

A 10-year-old Hindu child who has just been diagnosed with diabetes is admitted to the pediatric clinical unit. The nurse is counseling the parents and child regarding the child's dietary needs. Which of the following statements by the nurse would be appropriate? 1. "It is very important for you to eat protein at each meal. Meat is an excellent source of protein." 2. "I understand that you do not usually eat fruit, but because you are diabetic, it will be essential for you to eat fruit." 3. "To be able to provide you with the best information about dietary needs, I need to ask whether you follow a vegan diet." 4. "Diabetes is a very serious illness. It may be necessary for you to consume foods that you are unaccustomed to eating."

3. "To be able to provide you with the best information about dietary needs, I need to ask whether you follow a vegan diet." Although some vegetarians eat eggs and drink milk, others follow a more restrictive vegan diet. Many Hindus are vegetarians.

A nurse is attempting to get a 5-year-old child's cooperation when auscultating heart sounds. Which of the following comments is most likely to elicit the child's cooperation? 1. "It's time for me to listen to your heart go boom boom." 2. "Did you know that your heart beats in your chest?" 3. "Would you like to listen to the sounds your heart makes?" 4. "Let me show you a picture of a heart and where I want to listen."

3. "Would you like to listen to the sounds your heart makes?" Although no action is foolproof, preschool children often want to play with the equipment that the nurse is using. Giving the child the option of listening to his or her own heart with the stethoscope would provide that opportunity.

A mother visits her child's primary health-care provider for the child's 12-month visit. The child weighed 2,800 grams at birth. Which of the following weights is most consistent with the expected weight for this child? 1. 7,500 grams 2. 8,000 grams 3. 8,500 grams 4. 9,000 grams

3. 8,500 grams Infants usually triple their birth weights by 12 months of age. 2,800 x 3 = 8,400 grams.

An 8-year-old child, who is post-op appendectomy, is playing with a set of building blocks. The child's pulse and blood pressure are slightly elevated above their presurgery levels. When asked what level the child would rate the postoperative pain on a numeric pain scale, the child states that the pain is "8 on a scale of 1 to 10." The child's primary health-care provider has ordered Tylenol (acetaminophen) and morphine sulfate for pain. Which of the following actions should the nurse perform at this time? 1. Report the child's pain level to the child's primary health-care provider. 2. Administer acetaminophen to the child based on the child's behavior. 3. Administer morphine to the child based on the child's rating of the pain. 4. Query the child about how the child is able to play with such severe pain.

3. Administer morphine to the child based on the child's rating of the pain. A child's rating on a pain rating scale is more accurate than a nurse's interpretation of the child's pain based on the child's behavior. The nurse should always believe the child's rating of the pain.

The abdomen of a 7-year-old child, whose percentile weight is slightly lower than percentile height, is being assessed. Which of the following findings would the nurse expect to see?1. Umbilical hernia on inspection 2. Liver below the right costal margin on palpation 3. Aortic pulsations on inspection 4. Spleen below the left costal margin on palpation

3. Aortic pulsations on inspection Umbilical hernias sometimes are seen in neonates. As the abdominal musculature improves, they often resolve on their own. The liver is felt below the right costal margin in neonates but not in school-aged children. Unless markedly enlarged, the spleen is not felt below the costal margin.

The nurse is assessing the reflex development of a 5-month-old child. Which of the following rudimentary reflexes would the nurse expect still to be present? 1. Moro 2. Trunk incurvation 3. Babinski 4. Grasping

3. Babinski The Babinski reflex usually disappears at 1 year of age. When reflexes last longer than expected, especially the grasp reflex, the child should be assessed for possible illness (e.g., cerebral palsy).

A mother tells the nurse that it is difficult to get her 4-year-old child to bed at night. Which of the following should the nurse suggest that the mother do? 1. Give the child a small present if he goes to bed when he is asked to. 2. Play a running game with the child right before bedtime. 3. Develop a bedtime routine that is followed every night. 4. Let the child stay up late on weekends if he goes to bed on time on weeknights.

3. Develop a bedtime routine that is followed every night. Just as in the toddler period, routines help preschool children to know what is expected of them. Children then are more able to meet those expectations. If the child is not always able to go to sleep at bedtime, he or she can look at books in bed.

An 8-year-old child is in the playroom drawing a picture. The child's painful dressing change is due to be performed. Which of the following actions by the nurse is appropriate? 1. Delay the dressing change until the child is finished playing in the playroom. 2. Perform the dressing change in the playroom while the child finishes drawing the picture. 3. Escort the child to the treatment room for the dressing change and back to the playroom once it is done. 4. Ask the child whether the dressing change should be performed at that time or after the child has finished the drawing.

3. Escort the child to the treatment room for the dressing change and back to the playroom once it is done. Both play and medical interventions are critical to the health and well-being of children. In the hierarchy of care, however, medical managements must take precedence. However, because a child's play and emotional integrity are so important, no treatment should take place in the playroom or, if possible, in the child's hospital room. All treatments and procedures should be performed in a treatment room.

A school nurse is providing an educational session regarding actions parents can take to assess whether or not their child is engaging in risk-taking behavior. Which of the following actions should the nurse recommend? Select all that apply. 1. Periodically search their child's room for illicit substances. 2. The morning after a party, ask their child what drinks and foods were served. 3. Have a conversation with their child when the child returns home from a date. 4. Before allowing their child to leave for the evening, know where the child will be. 5. Be alert for changes in the child's usual behavior, including a change in friendship groups.

3. Have a conversation with their child when the child returns home from a date. 4. Before allowing their child to leave for the evening, know where the child will be. 5. Be alert for changes in the child's usual behavior, including a change in friendship groups. It is recommended that parents have a conversation with their child when the child returns home from a date. It is recommended that parents know where the child will be before allowing their child to leave for the evening. It is recommended that parents be alert for changes in the child's usual behavior, including a change in friendship groups.

The nurse is preparing to palpate a 2-year-old girl's tongue during a physical examination. Which of the following actions would help to prevent the nurse from being bitten? 1. Have the parent open the girl's mouth. 2. Ask the child to open her mouth big and wide. 3. Hold the toddler's cheeks with the fingers of one hand. 4. Place a tongue blade in the middle of the tongue.

3. Hold the toddler's cheeks with the fingers of one hand. Holding the child's cheeks with one hand is the best method. The jaw is kept open by gentle pressure exerted through the cheeks.

A nurse advises the parent of a 2-year-old that the child will have blood drawn during that day's well-child checkup. The nurse should advise the parents that the child's blood levels are being checked for which of the following substances? 1. Calcium 2. Mercury 3. Lead 4. Fluoride

3. Lead Two-year-old children are assessed for elevated levels of lead. Nurses should be familiar with routine assessments that are performed at well-child checkups

The nurse is assessing a 5-year-old child with a possible fractured leg following a bicycle accident. Which of the following actions would best determine the child's pain level? 1. Observe the child's behavior. 2. Ask the child, "How bad does your leg hurt?" 3. Provide the child with a pain rating scale. 4. Ask the parent, "How much pain do you think he is in?"

3. Provide the child with a pain rating scale. Just as when working with adults, when children use pain scales to rate their pain, the nurse obtains an objective determination of the severity of the child's pain. There are pain scales for all age patients, from nonverbal neonates through to adults.

A 7-year-old child, who must have a lumbar puncture, begins to cry and squirm when the nurse advises him that he must lie curled on his side with his back facing the primary health-care provider. Which of the following actions should the nurse perform at this time? 1. Advise the child that he must remain still during the procedure or else he will get injured. 2. Question the parents regarding how to get the child's cooperation for the procedure. 3. Request the assistance from another nurse to hold the child still during the procedure. 4. Tell the child that children who are in elementary school are big enough to be still during procedures.

3. Request the assistance from another nurse to hold the child still during the procedure. Young children are often unable to remain still during treatments and procedures. To assist them to remain still, the nurse should hold the child in the appropriate position. This action is called therapeutic holding. If the nurse is unable to hold the child by himself or herself, the assistance of one or more other health-care practitioners should be requested.

A nurse is educating the parents of a child with an atrial septal defect regarding the child's condition. Which of the following information would be appropriate for the nurse to provide? 1. The baby becomes cyanotic because the blood is owing through a hole from the right side of the heart to the le side of the heart. 2. The baby has a murmur because there is a hole between the aorta and the pulmonary artery. 3. The baby's heart is working harder than a normal heart because some of its blood is reentering the pulmonary system. 4. The baby's heart rate is slowed because of the high number of red blood cells in the blood

3. The baby's heart is working harder than a normal heart because some of its blood is reentering the pulmonary system. In the case of an ASD and other acyanotic defects, the blood is reentering the pulmonary system as a result of left to right shunting.

A mother asks which toy the nurse would suggest she purchase for her 15-month-old child. Which of the following would be appropriate for the nurse to recommend? 1. Model kit 2. Rattle 3. Toy shopping cart 4. Board game

3. Toy shopping cart Children who are 15 months old are mastering the act of walking. They can practice walking while pushing a toy shopping cart.

The mother of a 1-month-old states that she is curious as to whether her infant is developing normally. Which of the following developmental milestones would the nurse inform the mother that the infant is expected to perform at this age? 1. Rolling from back to front 2. Smiling and laughing out loud 3. Turning head from side to side 4. Holding a rattle for ten seconds

3. Turning head from side to side At one month of age, children still perform basic skills like moving their heads from side to side.

A kindergarten child, who has developed a fever since arriving at school, is resting in the school nurse's office. It is 11:30 a.m. The child asks, "When is my mommy going to get me?" The nurse knows that the mother will arrive in approximately 30 minutes. Which is the best response for the nurse to give to the child? "Your mommy should get here: 1. in about a half hour." 2. when both hands on the clock reach 12." 3. when lunch time begins for everyone." 4. at 12 o'clock noon."

3. when lunch time begins for everyone." As defined by Piaget, preschool children's cognitive stage is at the preoperational level. They view their world directly, unable to conceptualize things or events. Connecting a new event to the time of a known event will help the child to understand when the new event will occur.

A 10-year-old child is in the hospital on bedrest with a diagnosis of rheumatic fever complicated by carditis. When the nurse responds to the child's call bell, the child states, "I hate this! I want to get up and play!" Which of the following responses is appropriate for the nurse to make at this time? 1. "I know that you are unhappy, but you must stay in bed so that you can get better and go home." 2. "What if we make a deal and I promise to let you get up for 10 minutes every 2 hours if you are very good the rest of the day?" 3. "I am sure that I can get the doctor to let you go to the playroom for 1 to 2 hours this afternoon." 4. "I am so sorry that you are unhappy, but what if I contact the play lady and have her bring you a selection of video games to play with?"

4. "I am so sorry that you are unhappy, but what if I contact the play lady and have her bring you a selection of video games to play with?" This is an appropriate statement. The nurse is empathetic and is offering a realistic solution to the child's unhappiness.

The nurse notes in a toddler's medical record that the child was adopted internationally at 1 week of age. The child has been diagnosed with a terminal autosomal dominant genetic disease. Which of the following statements would be appropriate for the nurse to make? 1. "I will provide you with a referral for a meeting with a genetic counselor regarding your pregnancy risks." 2. "It is very important that the mother be notified of the baby's genetic condition." 3. "What a shame that you adopted a sick child rather than a healthy child." 4. "If you would like to learn more about your child's disease, I can refer you to a genetic counselor."

4. "If you would like to learn more about your child's disease, I can refer you to a genetic counselor." This statement is appropriate because the disease is genetic, the professionals who are most knowledgable about the disease are genetic counselors.

The mother of an 11-month-old states, "My child has 8 teeth. I brush them every morning with bubble gum-flavored toothpaste. My child loves it." Which of the following responses by the nurse is appropriate? 1. "That is great. Even though they are baby teeth, it is very important to brush them with toothpaste." 2. "I am so glad to hear that your child loves the toothpaste. So many babies get cavities because they refuse to use toothpaste." 3. "I am very happy to know that you are cleaning your baby's teeth, but I am afraid that the bubble gum flavor will spoil him." 4. "It is wonderful that you are brushing your child's teeth, but it is recommended for you not to use toothpaste."

4. "It is wonderful that you are brushing your child's teeth, but it is recommended for you not to use toothpaste." The vast majority of toothpaste on the market contains fluoride. When exposed to toothpaste, no matter which flavor, infants will swallow it simply because they have yet to learn how to spit out on command. To prevent a fluoride overdose, it is recommended that toothpaste not be used until the child is able to spit out on command.

The nurse is interviewing a parent of a 2½-year-old child. The parent states, "We are very careful about what our child eats and drinks. For example, we always give our child bottled water to drink." Which of the following responses is most appropriate for the nurse to make? 1. "That is an excellent practice. It is so important for children to learn to drink water." 2. "I am so glad to hear that. Many children consume drinks that contain empty calories." 3. "Many parents give their children bottled water, but unless you have been told that your water is dangerous, it is fine to serve water from the tap." 4. "It is your choice to serve your child bottled water, but it is important to check the bottle to see what substances may have been added to the water."

4. "It is your choice to serve your child bottled water, but it is important to check the bottle to see what substances may have been added to the water." There are a number of waters on the market that contain substances (e.g., vitamins, electrolytes, flavorings, caffeine, and sweeteners). Alkaline water has a higher pH level than does plain tap water. In addition, most bottled water does not contain fluoride. Toddlers should consume only plain water, and they do need fluoride for the health promotion of their teeth

A mother of a 2 1/2 year old calls the health-care provider and states, "I don't know what to do. My son keeps taking off his diaper in public and playing with his penis." Which of the following responses by the nurse is appropriate? 1. "Slap his hand, and tell him that that behavior is unacceptable." 2. "He should be given a time out every time he does that." 3. "Laugh at him, and say that you understand that it feels good to play with his penis." 4. "Simply put his diaper back on, and tell him that he should do that in his own bedroom."

4. "Simply put his diaper back on, and tell him that he should do that in his own bedroom." The Eriksonian stage of the toddler period is autonomy versus shame and doubt. The child who is able to remove his diaper and masturbate is exhibiting autonomous behavior that, to him, is pleasurable. When reprimanded and disciplined, the child believes that the action is wrong and he may develop feelings of guilt or shame.

A 5-month-old girl's arms are encased in elbow restraints following facial surgery. Which of the following situations would warrant removal of the restraints? 1. Narcotic medication has been administered, and the child's pain rating has dropped. 2. Infant has been put to sleep for the night in her crib lying on her back. 3. The infant's hands are pink with spontaneous movement and capillary refill of two seconds. 4. A responsible adult is holding the baby and preventing her from touching the operative site.

4. A responsible adult is holding the baby and preventing her from touching the operative site. Restraints should only be used when necessary and never should be applied as punishment. If a responsible adult is able to monitor the child's actions and prevent injury to the therapeutic sites, restraints should be removed.

A nurse is assessing a 1-day-old sleeping baby in the well-baby nursery. Which of the following assessments should the nurse report to the neonatologist? 1. Temperature 97.9 F 2. Blood pressure 77/46 3. Respiratory rate 52 4. Apical heart rate 179

4. Apical heart rate 179 Normal heart rate in a newborn is 110 to 160 bpm. A rate of 179 is well above normal. Tachycardia in a neonate may indicate the presence of cardiac disease.

The nurse is giving a 5-year-old child a vaccine injection. The child cries loudly during the procedure. Which of the following interventions would be appropriate for the nurse to perform after the injection? 1. Advise the child that big children are quiet during injections. 2. Explain to the child why vaccinations are administered. 3. Inform the child that the vaccine was ordered by the primary health-care provider. 4. Comfort the child and give the child a sticker as a present.

4. Comfort the child and give the child a sticker as a present. Preschoolers may view injections as a form of punishment for poor behavior or for bad thoughts. To counter those misunderstandings, the nurse should comfort and praise the child for having successfully undergone the painful procedure.

The nurse assesses a 2-month-old girl. The baby weighed 3,400 grams at birth, 3,800 grams at 1 month, and 4,000 grams at 2 months of age. The nurse plots the information on the scale below. Which of the following conclusions and actions would be appropriate for the nurse to make? 1. Conclusion: the child's growth is normal. Action—no change: the baby is growing appropriately, therefore no feeding changes are needed. 2. Conclusion: the child's growth is excessive. Action—change: the baby is overweight, and the information should be reported. 3. Conclusion: the child's growth is inconsistent. Action—no change: the baby's weight was larger than normal at birth, but the current weight is appropriate. 4. Conclusion: the child's growth is below expected. Action—change: the baby's weight is markedly lower than normal, and the information should be reported.

4. Conclusion: the child's growth is below expected. Action—change: the baby's weight is markedly lower than normal, and the information should be reported. This baby needs to have a thorough physical assessment, and the parents need to be thoroughly queried regarding the child's feeding, urinary, and stooling patterns.

The nurse has performed physical assessments on 4 preschool children who have been referred for potential genitourinary problems. It would be appropriate for the nurse to report to the primary health-care provider that which of the children's findings is not within normal limits? 1. Circumcised male child: soft scrotal sac with no palpable masses. 2. Female child: wide-spread labia majora. 3. Uncircumcised male child: foreskin that resists being retracted. 4. Female child: vaginal discharge with fishy odor.

4. Female child: vaginal discharge with fishy odor. The vaginal discharge should have no odor. Further investigation is warranted.

A newborn baby is receiving digoxin (Lanoxin) and furosemide (Lasix) for congestive heart failure. Which of the following actions would be appropriate for the nurse to perform? 1. Hold digoxin if the apical heart rate is 170 bpm. 2. Hold digoxin for a digoxin level of 1 ng/mL. 3. Hold both the digoxin and furosemide for a weight increase of 5% in one day. 4. Hold both the digoxin and the furosemide for a potassium 3.2 mEq/L.

4. Hold both the digoxin and the furosemide for a potassium 3.2 mEq/L. A serum potassium level of 3.2 mEq/L is well below the normal for a newborn of 3.7 to 5.9 mEq/L. The nurse should hold both medications and notify the health-care provider who ordered them.

A nurse is having difficulty communicating with a hospitalized 5-year-old child. Which of the following techniques is appropriate for the nurse to use to improve communication? 1. Have the child keep a diary of his or her feelings. 2. Read a fairy tale about scary adventures to the child. 3. Ask the mother to interpret the child's feelings. 4. Interact with the child through nurse and patient puppets.

4. Interact with the child through nurse and patient puppets. Although preschool children are able to use all forms of speech, they are often unable clearly to put their feelings into words. Preschool children use imagination and play in their everyday lives. Puppetry can be an excellent means of utilizing play to foster communication.

The parents of a 2-year-old child state that their child begins nursery school in one week. Which of the following actions should the nurse advise the parents to perform on the child's first day of school? 1. When dropping the child off at school, quickly leave the classroom when the child is not looking. 2. When preparing the child for the first day of school, tell the child that teachers do not like bad boys and girls. 3. Tell the child that big boys and girls never cry on their first day of school. 4. Make sure to let the child take to school any special object the child is attached to.

4. Make sure to let the child take to school any special object the child is attached to. Toddlers are engaged in the Eriksonian stage of autonomy versus shame and doubt. Although they strive for independence, the process can be very stressful for them. Holding a transition object during a new experience can help them to make the transition from the safe environment of home to a new environment.

The nurse is assessing the accommodation of a child's eyes. Which of the following techniques would be appropriate for the nurse to perform? 1. Ask the child to follow the nurse's fingers in all six quadrants. 2. Have the child cover one eye and read from a vision chart. 3. Use an ophthalmoscope to assess for the red reflex. 4. Move a puppet away from and close into the child's field of vision.

4. Move a puppet away from and close into the child's field of vision. The muscles of the iris change when the eye accommodates from distance to close vision. The nurse can assess that change when a child looks at an object that is moving from close up to far from the child.

A student informs the school nurse that she is planning to get a tattoo. Which of the following information should the nurse teach the student about tattoos? 1. Tattoos are easily removed with lasers and bleach. 2. The student should request that only blue and red dye be used. 3. Infections are rare because tattoo needles and inks are kept hot. 4. Skin lesions may develop where tattoos are placed.

4. Skin lesions may develop where tattoos are placed. Tattooing and piercing are popular among adolescents. Teens should be thoroughly educated regarding the pros and cons of the actions so that they can make informed decisions regarding whether or not to have them placed.

The nurse is providing prehospital admission education to a 9-year-old child and family. Which of the following methods would be most appropriate for the nurse to utilize during the teaching session? 1. Have the child speak with another child who was recently discharged from the hospital. 2. Verbally explain to the child what the child will experience while in the hospital. 3. Play a board game about hospitals and medical procedures with the child. 4. Take the child on a tour of the pediatric unit, and introduce the child to the nurses.

4. Take the child on a tour of the pediatric unit, and introduce the child to the nurses. School-age children are in Piaget's stage of concrete operations. They learn best by experiencing the information to be learned directly. Taking the child on a tour of the hospital would provide the child with that direct experience.

The nurse is performing a whisper test when assessing the hearing of a 10-year-old child. Which of the following actions would be appropriate for the nurse to perform? 1. While assessing the tympanic membrane, ask the child to whisper the words, "It does not hurt when you do that." 2. Ask the child to whisper into the nurse's ear in as soft a voice as possible. 3. Ask the child whether or not he hears his friends when they whisper to him. 4. While standing behind the child, whisper "stand on one leg" and observe to see if the child performs the command.

4. While standing behind the child, whisper "stand on one leg" and observe to see if the child performs the command. To make certain that the child does not become startled by the nurse's actions, the child should be forewarned of the whisper test. To make sure that the child is not lip reading, the nurse should stand behind the child while conducting the test.

A 15-month-old child, who is being dropped off at nursery school, throws himself onto the floor, kicks, and screams, "No! No!" Which of the responses by the mother should the nursery school nurse recommend the mother change in the future? a. The mother turns her back on the child while he is kicking and screaming. b. The mother bends during the tantrum and states,"Honey, why are you so upset? We need to discuss your behavior." c. After the tantrum is over, the mother turns around and states, "I am so proud of you when you act like a big boy." d. After the tantrum is over, the mother bends downand gives her son a hug.

b. The mother bends during the tantrum and states,"Honey, why are you so upset? We need to discuss your behavior." A parent who appears sympathetic during the tantrum is reinforcing the negative behavior. An excellent parental response to temper tantrums is to ignore the poor behavior and quickly reinforce appropriate behavior after the tantrum stops.

A 2½-year-old boy is being seen by the primary health-care provider for a well-child checkup. Which of the following statements by the mother would indicate a need for teaching? a. "I bought a potty seat and put it into the bathroom next to the toilet. Johnny sits in it sometimes." b. "I worry that Johnny will get too close to the hot oven, so I put him in his playroom and have him play by himself with his toys while I'm making dinner." c. "When Johnny has a bottle with him in his crib, he goes to bed so much more easily. He drinks the water, and it helps him to go to sleep." d. "My husband and I converted Johnny's crib into a toddler bed because he climbed out of the crib twice last week."

c. "When Johnny has a bottle with him in his crib, he goes to bed so much more easily. He drinks the water, and it helps him to go to sleep." This action should be questioned because toddlers are immature and inquisitive. It is inappropriate to leave them unsupervised.

A mother reports to the nurse that she administers a vitamin to her toddler every morning. The nurse should praise the mother for using which of the following methods of administration? a. Mother gives her child a vitamin each morning. When doing so, she states, "Here's your medicine. It tastes just like candy." b. Mother leaves the vitamin pill bottle on the kitchen table. In the morning, mother states, "Take out your vitamin, and chew it up good." c. Mother locks the vitamins in the medicine cabinet. When giving her child the vitamin, mother states, "Remember, only Mommy is able to give you the medicine." d. Mother keeps the vitamins on top of the refrigerator. When giving the child the vitamin, mother states, "Remember, you must never climb on the counter to get your vitamins."

c. Mother locks the vitamins in the medicine cabinet. When giving her child the vitamin, mother states, "Remember, only Mommy is able to give you the medicine." Parents may believe that toddlers are unable to access medicines and other unsafe items in high places, but toddlers could climb up on chair or on the counter.